Registration Quality & Payment Estimator Tools – Lessons Learned 7+ Years In The Making!

1. Registration Quality & Payment Estimator Tools – Lessons Learned7+ Years In The Making! Patient Access: Getting It Right “Upfront” October 23, 2012 Katherine H. Murphy, CHAM, VP Revenue Cycle Consulting Marcus Padgett, Sr VP Revenue Cycle Solutions Passport Health Communications, Inc.

2. The Way We Were

3. Life is good!

4. Points of Discussion • Where can I see it in my HIS system? • ROI on Quality Assurance • The dirty secret about ScoreCards • Accuracy of estimates • Why are some implementations and changes so difficult? • Why are some easy? • What don’t you need to do? • What do you need to do?

5. How Can I Do A Site Visit? • HL7 is a standard ADT interface format • HL7 is system agnostic • You will see it the same everywhere • Great Users are really the best references to discuss product success & process change • SAVE your $$ and do a Virtual site-visit?! Site visit? Site visit? Site visit?

6. Who Owns ROI? You! • Vendor provides guidance • You know your problems • Payer mix • Denials-missing authorization, wrong code, no coverage, wrong address • Volume X cost of business re-work + payment reduction or denials • Policies, Politics and Payments?

7. REGISTRATION QUALITY TOOLS POSITIVE vs. PUNITIVE

8. Define An Error • Do all errors count • Are all errors equal? • If some errors are “less critical” what message is sent? • Do Errors count if resolved in given timeframe? • Just let me see the scorecard so I don’t have to think about this.

9. Define An Error • Wrong insurance = eligibility not found • Is it an error if it is corrected immediately? • Alerts vs. errors (dob) • It happened once last summer… • Alert fatigue = user breakdown

10. Alert Fatigue Definition: Over alerting/reminding Examples: • Missing SS# • Patient Over 65-No secondary • MSP Questionnaire required • Copy of Insurance Card (I.D., etc) required • Please ask patient about other health coverage (COB)

11. Alert Fatigue Alert Value • Cleans HIS database • 72% repeats • Next registrar has a correct account • Patient/employee satisfaction / Claim first pass • Denial Prevention / minimize account rework • You can trend how well the tool is managed more easily than how well the registrar has improved

12. High Value • Identifies Medicare Replacement plans • Identifies Medicaid Managed care plans • Wrong insurance codes (HMO, PPO, POS etc) • Blank required fields • Address discrepancies (patient/guarantor) • MSP • Things affecting claim quality, billing information & payment

13. The Dirty Secret About Scorecards • ScoreCard Fatigue? User failure? Manager? • Scores Manager: • Staff accountability • Staff education • Staff use of automated tool • Error management & reduction

14. Automated Patient Liability Estimators HOW? - WHEN? - WHERE?

15. HowAccurateAre Estimates? • 100% accurate • 100% inaccurate • A mix? • We still have to deal with averages!!!! • As accurate as you are + doing only the procedure you identified, provided that….

16. Why Are Estimates Inaccurate? • The user selected the wrong procedure • The wrong insurance code was selected and not fixed before the estimate was run • A procedure was added on after the estimate • Not all of the same surgeries will be the same • Dealing with the unknown • Co-morbidities….. • Chargemaster updates • Contract updates • Benefits not always there GUESStimate

17. Pick Your Spots! • Transparency • Self pay patients • Deductibles • High Dollar scheduled services • All scheduled patients • etc

18. Pick Your Spots Well! • The value of POS collection • Medicare? • Medicaid? • ER • Secondary Insurance ? • Scheduled • Walk-ins • Co Pay? • Co Ins? Etc.

19. Think It Through Thoroughly!

20. Be User Friendly! Crawl Before you Walk! Or CDM Desc Easy Search Desc? Determine sophistication of the user & organizational goals

21. Medicare Estimates = Interesting Science • What is the value of informing Medicare Patients of what they own pre-service? Lab: • Service indicated upon point of entry may not be what is performed • Most have a supplement or Medicaid and if they don’t they likely qualify for some financial assistance.  • Determine the value of the investment on both sides of the coin – vendor and provider/patient • Confusion about what they owe in general  - after all we have given them Part D donuts and Medical Necessity ABNs which get overturned routinely. Not to say this shouldn’t be done of course!

22. Medicaid, Emergency Room • Medicaid: Little to No value/Co-pay • Emergency Room – What’s the best you get? Cartside? Co-pay for managed care ER Service Level / + generic Imaging Do it at discharge – Requires teamwork *Self Pay Deposit*

23. Give me the details and no one gets hurt The Misc Details Things You Need To Know!

24. Why Are Some Implementations Easy? • Project champions • Involve the right people (listening to the users) • Support from executive level • Policies to back you up • Vanilla, strawberrythenchocolate • The wheel is already invented – try it first

25. What Makes An Implementation Difficult? • Unrealistic expectations (What was I thinking?) • Going full throttle - Chocolate • Lack of champion at user level • Failure to pick your spots • Square peg round hole • Reinventing the wheel • Lack of education • Lack of management engagement • Policies don’t back up the process

26. What You DON’T Need To Do • …measure things that don’t need to be measured • …be punitive • …be 100% day 1 • …hold staff accountable without holding yourself accountable

27. What You Need To Do • Start small and standardize processes • Be visible/accessible to the users (change management) • Solicit user feedback • Measure things that need to be measured • Increase accuracy • Increase collection • Provide users with control for real-time feedback

28. Integration Advantages • Transparency in workflow • User friendly - minimal training • Discrepant data auto updated • Applications/forms auto-populated & account specific • Creation of system generated reports/work queues/work lists • Paperless

29. Automation Changes How We Work! • Opportunity for positive change • Opportunity for new levels of success • Process consistent throughout the enterprise • Eliminate: we’ve always done it this way • Eliminate fear: if we automate will I still have my job? • Share the financial success story with users!

30. Questions To Ask Yourself • Will the automation be efficient in the environment? • Do the physicians, staff and patients realize a benefit? • Is it easy to use?Is a lot of training required? • Am I paying for bells & whistles that I don’t need? • Is the data something that needs managing? • Is the program customizable without costs? • Implementation time? What changes can I maintain? • Did I rewrite policies to align with the changes?

31. Key Reports Q.A. • Errors by department/location • Insurance errors (eligibility not found • Accounts/Errors by user not fixed in designated time frame • Number of time a rules fires • Scorecard to review overall dept & Mgmt performance Estimator • Amount estimated vs Actual collected-user, dept, payer, payment type • Procedures estimated vs Actual billed • Accounts for which no estimate was run

32. The Danger of Over-Reporting • Misunderstanding the data • Delay in process change (the person who makes the error is not responsible for corrections) • Date and time of errors • Who whowho (Did it? Fixed it? Touched it?) (“can you tell who looked at it but didn’t fix it?”) WHO CARES? • Lack of Focus on priority - a clean workqueue? • Failure to understand the reflection on management!

33. Cindy • Not magic wand – sprinkles magic over all the Achilles heels of process and desires • Ongoing process like putting a glove on the hand. Work it down between the fingers until it fits right for your desired outcomes. • Ticket to defeat = multiple products at the same moment. Pick your spot and complete and move to the next products. Let dust and staff settle (& customers) be comfortable with change.

34. Cindy • Immediate success attained when you limit services for estimation and collection • Keep in mind the 80/20 rule because chasing minutia will not strike a balance with throughput goals • Over-engineering – death spiral for success • 16 Hospital system – nurture your champion to promote the cause – (Monica) “You have the opportunity to be perfect before you are evaluated. The QA tools give you this chance.”

35. Julia • Use the tools throughout the Revenue Cycle, not just in Patient Access. QA encompasses the Revenue Cycle • Let the vendor direct the process at the start. They are a value add resource to customers based on experience. • Are the alerts/rules patching a bad process? • Alerting the user when NOT to do something instead of when it is required (lack of faith) • Success is dependent upon the manager embracing the engagement

36. Lionel • Don’t try to Dummy proof everything • Realistic goals for the tools & users – build on this • Pick a testing team of super users for champions • No amount of testing will catch everything • Don’t implement and walk away from it

37. Katrina • Products mature over time – external and internal feedback creates excellence and confidence in the partnership • Absence of features can be a golden opportunity for partners • Asking to build things that couldn’t be built – not understanding they are not in HL7 • User does not question or address possible problems within the application – assuming it is correct or assuming it is incorrect but they can’t do anything about it

38. Katrina • Lack of appropriate stakeholders • Bad reporting – ineffective filters and maintaining old processes Blasting on the faucet: • Running PPE on every patient – Medicaid, w/c, sexual assaults, Medicare labs, reference labs, prisoners, victims of crime. (Getting users used to estimates!) • Running estimates standalone when Doctor’s office scheduled patient & before EV, preregistration

39. Candace • Even 5010 Payer data needs massaging - message segments and notes fields are where the payers have a free for all with the rules (like nailing jell-o to a wall) • Prioritize the value add of features you request • Historical data from 837 files – powerful tool • Should low level clerical workers be using a highly complex tool like an estimator? It is not just plug & play. There is intuitiveness, industry savviness and revenue cycle training required to operate this machinery safely.

40. Poor User • This thing doesn’t work • It takes too much time (so you’d rather rework?) • I like the way we worked before • It takes too much time (I hate asking for money) • We’re different

41. GoodUser “If they took this away from me I would call in sick tomorrow!”

42. QUESTIONS? Share YOUR experience? Share YOUR experience? • Katherine H. Murphy, CHAM, VP Revenue Cycle Consulting • Marcus Padgett, Sr VP Revenue Cycle Solutions • Passport Health Communications, Inc. • Katherine.Murphy@Passporthealth.com • (630) 916-8818 x234 • (630) 926-0779 QUESTIONS?